Provider Demographics
NPI:1043271265
Name:CUNNINGHAM, TRAVIS R (DC)
Entity type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:R
Last Name:CUNNINGHAM
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3715 E OVERLAND RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-8395
Mailing Address - Country:US
Mailing Address - Phone:208-888-0055
Mailing Address - Fax:208-888-5062
Practice Address - Street 1:3715 E OVERLAND RD
Practice Address - Street 2:SUITE 105
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-8395
Practice Address - Country:US
Practice Address - Phone:208-888-0055
Practice Address - Fax:208-888-5062
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1252111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV07860Medicare UPIN
ID1673182Medicare UPIN
NV101857Medicare ID - Type Unspecified